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Coping with Fragmented Payment in the Real World

Friday, April 13, 2012

Many analysts and policymakers agree that the fragmentation of the health care delivery system results in uncoordinated care, frustrated patients, higher costs, wasted administrative dollars and lost opportunities for rapid improvement in our health care system. There is less agreement as to how to reform health care payments in order to harmonize health care delivery and reduce this fragmentation. How do institutions, communities and practitioners transform their organizations to deliver high-quality, patient-centered care when different payers pay at different rates, and some patients have no one paying at all?

These experts focused on three communities that have reformed and harmonized health care payments across payers to improve care: a New York health system that serves a low income population; a Colorado community that pools money from public and private sources to provide care for all patients; and the State of Maryland, which has been using an all payer hospital rate setting system for years to control hospital costs and help cover the cost of care for their uninsured.

Webcast: The Emerging Biosimilars Market

Open Enrollment Preview: Checking the Vitals of the Marketplaces

The Affordable Care Act's health insurance marketplaces rely on robust competition to control costs and to provide consumer choice. But the decisions of several large insurers to scale back their 2017 marketplace participation, and the failure of many health insurance co-ops will leave marketplace shoppers in many states with fewer choices than they had in 2016. Furthermore, those insurers remaining in the exchanges have often found their marketplace customers to be less healthy than they projected, and they are raising premiums in response. Our briefing focuses on these trends, what they mean for the long-term viability of the marketplaces, and what public policy steps can be taken to bring more healthy people into the risk pool and to encourage insurer participation in the individual market.